General Surgery Coding Alert

Read the operative note carefully and apply modifier -22 when justified

If you're not reading the surgeon's operative notes for laparoscopic cholecystectomy (lap chole) carefully, you could be missing billable services such as cholangiography or lysis of adhesions and leaving dollars on the table. At the same time, you must avoid overcoding laparoscopic-to-open conversions by claiming only the successful procedure. Step 1: Determine EVERYTHING the Surgeon Did  When coding for lap chole (laparoscopic removal of the gallbladder), you should  carefully read the body of the operative report (not just the summary) to be sure that you are reporting every procedure the surgeon performed.
 CPT includes three codes to describe lab chole, each of which is more extensive (and therefore pays at a higher rate) than the code it follows:

  47562 - Laparoscopy, surgical; cholecystectomy
  47563 - ... cholecystectomy with cholangiography
  47564 - ... cholecystectomy with exploration of common duct.   "Many surgeons perform cholangiography [radiologic examination of the bile ducts] as a standard component of cholecystectomy," says M. Trayser Dunaway, MD, FACS, a general surgeon in private practice in Camden, S.C. "Because the surgeon considers the cholangiography routine, he or she may fail to note the procedure in the operative report summary. If you don't read the body of the operative report, you may miss the cholangiogram, as well as the reimbursement that comes with it."
 
Use one code to describe cholangiography and common duct exploration: If the surgeon performs both cholangiography and exploration of the common bile duct (to locate and remove gallstones, for instance) you should report only 47564. The National Correct Coding Initiative (NCCI) bundles 47563 into 47564. The edit pair includes a "0" modifier indicator, meaning that you may never override the edit. Payers will always include the work involved in 47563 into 47564. Step 2: Look for Modifier -22 Opportunities When reading the operative report, you should also scan for evidence of additional work - such as extensive lysis of adhesions - that may provide an opportunity for added reimbursement using modifier -22 (Unusual procedural services).
 
"You should use modifier -22 sparingly and with care. But in cases when the surgeon performs significant, documented additional work, you're doing yourself and the surgeon a disservice by not attaching the modifier," says JoAnn Baker, CCS, CPC-H, CPC, CHCC, owner of Precision Coding and Compliance, Hackettstown, N.J.
 
Supply rock-solid documentation: Generally, coding experts recommend that the surgery should require at least 25-30 percent additional time or effort to complete before you should consider appending modifier -22. And, your documentation should specifically and explicitly describe the unusual [...]